1. Cervical Sample Taker Training 2015 THE NHS CERVICAL SCREENING PROGRAMME (NHSCSP)

2. Aims of the NHS Cervical Screening Programme To reduce the incidence of and mortality from cervical cancer This is achieved by offering regular screening to all women at risk so that conditions which might otherwise develop into invasive cancer can be identified and treated

3. History of cervical screening in the UK Cervical screening began in the mid-1960s The NHSCSP was set up in 1988 with the introduction of computerised call and recall systems

4. Screening programmes Condition must be an important health problem Natural history of disease must be understood Acceptable test Eligible population known Good coverage Agreed policy on management Effective treatment Good quality assurance Economically balanced

5. Natural History of Disease Pre-malignant condition can be detected Cervical Intraepithelial Neoplasia (CIN) CIN1, CIN2, CIN3 Low and High grade dyskaryosis CIN is NOT cancer

6. Risk factors for cervical cancer Factors that increase risk include: persistent infection with high risk types of the human papillomavirus (STI) – Any activity that increases the woman’s chance of catching HPV…examples? Smoking immunosuppressive disorders, including HIV infection not attending for screening

7. Risk factors for cervical cancer (cont.) Factors that reduce risk include: regular attendance for screening regular condom use total hysterectomy for other reasons

8. Eligible women Those aged 25-64 who have a cervix

9. Women under age 25 Cervical cancer is rare Increased rates of borderline changes Risk of over-treatment Screening would do more harm than good Evidence reviewed in 2009 – Still considered robust – Symptoms should not be ignored

10. Age-specific incidence rates and number of cases of cervical cancer diagnosed by five year age group, England 2008

11. Some cases of cervical cancer in this age group have had delayed diagnosis because symptoms not investigated appropriately. New guidance published in 2009

12. Women over 65 Will be removed from routine recall Unnecessary additional tests may be rejected Test will be accepted if: – Follow up for abnormal sample (remains on recall system) – If woman has never had a cervical sample taken

13. How often to attend for screening? Age group (years)Frequency of screening 25First invitation 25–493 yearly 50–645 yearly 65+Only screen those on follow-up for an abnormal result, or women who have never been screened

14. Unscheduled tests - interval – Laboratory will accept a sample 3 months in advance of it being due but no sooner – Symptoms do NOT warrant earlier repeat Vaginal Bleeding Vaginal Discharge Contraception/HRT Pregnancy or postnatal services Genital warts Multiple sexual partners Smokers Family history of cervical cancer These do NOT warrant taking a cervical sample if it is not due

15. Additional samples may be taken if: HIV positive (annual) Renal failure (possibly one additional test) These women will be under care of a gynaecologist for any additional samples or specialist centre

16. Unscheduled Tests – General Rule If a woman has not received a letter from the PCSA inviting her for a cervical screening test: – DO NOT TAKE A SAMPLE!

17. Ceasing recall Women over 65 should cease recall Women who have had a TOTAL hysterectomy Women who have had radiotherapy for cervical cancer Patients informed choice

18. Informed choice All women must be given the opportunity to make an informed choice about whether or not to attend for cervical screening If woman refuses test she will be sent another invitation in 3/5 years Refusal does not necessarily mean ceasing from recall

19. Cervical Screening - Coverage

20. Non-attendance – why? Fear Worry about result Embarrassment Lack of understanding Language barriers Previous experiences Unable to get convenient appointment It wont happen to me… I didn’t realise I was at risk…

21. Aims of the NHS Cervical Screening Programme To reduce the incidence of and mortality from cervical cancer This is achieved by offering regular screening to all women at risk so that conditions which might otherwise develop into invasive cancer can be identified and treated

22. Trends in incidence and mortality, England 1988 to 2008 Cervical Cancer in England 1988-2008